I have panic attacks and I have a dental problem that is getting worse. It is an on again off again toothache that I know is a cavity that needed filling a couple of years ago and now is much worse. I just can’t bring myself to sit in a dentist chair. I know I will have a panic attack. I am at the point where I can’t really not deal with this any longer. Do you know if I go to my doctor and ask her for some medicine if she will give me a lot of valium of something similar so I can maybe survive the dentist by being as good as passed out? I am not joking. Do you have any advice for me on this? There is only dentist in my area covered under my plan and she does not use laughing gas ever. I am not in a position to pay for expensive dental surgery off plan.

Dr. Richard Schultz Says...

Hello and thank you very much for writing to me about your challenging situation. I am sorry for the distress and will do my best to guide you in overcoming it constructively.

Of course, it is quite understandible that individuals with a predisposition to panic, and/or those who are phobic about feeling "trapped" ("I just can't bring myself to sit in a dentist chair") may have great difficulty in a wide variety of life circumstances; these conditions can be triggered virtually anyplace that arouses uncomfortable thoughts and emotions related to perceived threat.

It will not surprise you to know that my very best mid- to longterm recommendtion is for you to engage in a course of cognitive-behavioral therapy to address the underlying anxiety condition(s). Please know that symptoms such as you describe are extremely prevalent and very effectively treated using appropriate psychological methods. Treatment is straight forward and typically yields significant improvement in as few as 6 sessions (this will vary widely across individuals). The primary requirement for success here will be your strong motivation to recover, and a willingness to tolerate some discomfort along the way. Your habitual, negatively reinforced avoidance of such uncomfortable situations, and the unwanted thoughts, feelings and physical sensations that arise in them, has been precisely the mechanism behind the condition's continuation and worsening. As it is said, "that which we resist, persists."

The primary goal of psychological treatment would therefore be to help you, via a variety of techniques, many involving exposure (cognitive, emotional and behavioral), to learn a new relationship and reaction to these situations, and to the psychological experiences they trigger. You did not pop out of the womb fearing the dentist's chair and you can certainly unlearn this reaction.

For the very short term, as your dental malady deserves immediate address, you can certainly speak with your primary care doctor about prescribing you with a small quantity of a minor tranquilizer (i.e. a benzodiazepine such as lorazepam, alprazolam or clonazepam) for use during the dental visit (and many dentists are themselves willing and able to prescribe same). Such a medication works by dialling down the reactivity of your sympathetic nervous system (a branch of the central nervous system). It is not designed to cause you to "pass out" (and there may indeed be very good reasons for you to remain responsive and alert during dental treatment), but rather to allow you a much softened response to the situation.

The use of a benzodiazepine is most certainly not going to be anything like a sustained cure for your anxiety, but it is very likely to help reduce the severity of your symptoms in this particular situation on this particular occasion, so that you can get your needed medical attention. Clarifying at the outset with the dentist that you will likely need to get up, walk around or go to the bathroom at various times during the procedure, due to symptoms of anxiety, is also recommended for the short-term scenario. Doing so will both inform the health care provider of your needs as a patient, and will also likely reduce your discomfort, as entitling yourself to this mobility, and exercising it during the procedure, will clearly show your brain that you are NOT actually trapped (although I certainly understand the intensity of this feeling). Please know that you may still very well experience symptoms of anxiety, even on a tranquilizer, but at a lower level of severity. Do not expect to feel 100% comfortable in the situation (any weight you can comfortably lift in the gym will not further develop your strength), and please do say to yourself, in anticipation of the office visit as well as during it, things like "I choose and accept this," and "I welcome the opportunity to strengthen myself by facing my vulnerability." To the degree you are willing to tolerate and allow the discomfort without negating, avoiding, overanalyzing, or hiding it, or judging yourself for having it, you will become stronger. To the degree you invest in "escape tactics," your fearful thoughts and feelings and bodily sensations will be reinforced.

So, in the interest of full disclosure, I must let you and every other reader know that the use of psychotropic medications to treat symptoms of anxiety is in no case considered the gold standard or holy grail of medical or psychiatric treatment. This is a well-replicated finding of research in this area. I have worked with thousands of individuals who continued to experience significant anxiety while on psychotropic medications designed to "treat" these very symptoms. To reiterate, the primary reason for this is because medication that reduces symptoms of anxiety is effectively functioning as an avoidance or safety behavior in it's own right, and is thus negatively reinforcing the continuation of the condition; although medication can bring short term relief to the discomfort, the symptoms will most likely recur without it or with it, and you will also then come to develop a fear of being without the medication!

So, do what you need to do to get your near term dental issue resolved, and then find a great psychologist and get to the ROOT of the problem (sorry, couldn't help myself!).

I hope you found some of this information useful, and I wish you peace and courage in your recovery. Please keep me posted about your progress and feel free to learn more about the treatment of anxiety on choosehelp.com, and on my blog and website (mindset.mobi and drschultz.org).